Chen-Wang Chang

Effect of Physician-Delivered Patient Education on the Quality of Bowel Preparation for Screening Colonoscopy

Background. Inadequate bowel preparation is common in outpatients undergoing screening colonoscopy because of unawareness and poor adherence to instruction. Methods. Herein, 105 consecutive outpatients referred for screening colonoscopy were enrolled in this prospective, colonoscopist-blinded study. The patients were assigned to an intensive-education group, with 10 minutes of physician-delivered education, or to standard care. At the time of colonoscopy, the quality of bowel preparation was assessed using the Boston Bowel Preparation Scale (BBPS). The primary outcome was a BBPS score ≥5. The secondary outcomes were the mean BBPS score, insertion time, adenoma detection rate, and number of adenomas detected. Results. We analyzed 39 patients who received intensive education and 60 controls. The percentage of adequate bowel preparations with a BBPS score ≥5 was higher in the intensive-education group than in the control group (97.4% versus 80.0%; P = 0.01). The adjusted odds ratio for having a BBPS score ≥5 in the intensive-education group was 10.2 (95% confidence interval = 1.23–84.3; P = 0.03). Other secondary outcomes were similar in the 2 groups. Conclusions. Physician-delivered education consisting of a brief counseling session in addition to written instructions improves the quality of bowel preparation in outpatients undergoing screening colonoscopy.

Enteroscopic Diagnosis and Management of Small Bowel Diverticular Hemorrhage: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases.

Small bowel diverticulum is a rare cause of gastrointestinal bleeding. The diagnosis and treatment of small bowel diverticular hemorrhage is clinically challenging before the development of deep enteroscopy. In this multicenter study from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID), 608 patients underwent deep enteroscopy for obscure gastrointestinal bleeding during January 2004 and April 2010 from eight medical centers in Taiwan. Small bowel diverticular hemorrhage account for 7.89% of obscure gastrointestinal bleeding in this study. Most of the patients received endoscopic therapy with an initial hemostasis rate of 85.71% and rebleeding rate of 20%. In this large case series investigating the enteroscopic management of small intestinal diverticular hemorrhage, we found that, as to patients with peptic ulcer hemorrhage, most of these patients can be successfully managed by endoscopic therapy before surgery in the era of deep enteroscopy.

A novel artificial tissue simulator for endoscopic submucosal resection training – a pilot study

BackgroundWe developed a novel artificial simulator for endoscopic submucosal dissection (ESD) as a bridge between instructional videos and animal tissue training and aimed to evaluate the feasibility of using an artificial tissue model in ESD training.MethodsEight gastroenterology fellows from one medical center were enrolled in this ESD training program. Before and after the simulator training, attendees indicated on a 5-point scale the degree of difficulty in performing the following procedures: lesion marking, mucosal pre-cutting, circumferential incision, submucosal dissection, and hemostasis. After the simulator training, the participants completed a questionnaire regarding their opinions on the degree of realism and the feasibility of using this model for training.ResultsAfter watching an instructional video, attendees felt that the most difficult techniques were submucosal dissection and hemostasis. After using the artificial tissue simulator model, the attendees felt more confident in performing performing lesion marking (p = 0.026) and submucosal dissection (p = 0.037). However, they still felt that hemostasis was the most difficult techniques to master. Overall, the attendees thought the simulator was realistic in simulated lesion marking and its use was feasible for simulated lesion marking and submucosal dissection.ConclusionOur pilot study shows the feasibility of using a novel artificial tissue in performing ESD and we believe that the artificial tissue simulator acts well as a bridge between instructional videos and animal model training. The model is reusable and inexpensive, and could disseminate the techniques of the ESD more easily and quickly.

Sarcomatous Hepatocellular Carcinoma

Sarcomatous hepatocellular carcinoma (HCC) is a rare subtype of hepatoma, along with worse prognosis than ordinary HCC. The risk of this subtype is still unknown, but some believed it has to be related to post anti-cancer therapy. We reported a case of sarcomatous HCC and the patient did not receive any anti-cancer therapy before. He came to our outpatient department due to symptoms of generalized malaise and poor appetite. One 10 cm in sized tumor was detected by ultrasound. He received surgical resection of the tumor but the tumor recurred after 3 months, with multiple metastases to peritoneum and brain. However, even under aggressive treatment, patient still expired in 6 months after operation. We reviewed several reports of this subtype of HCC. It was known that sarcomatous HCC is hard to be distinguished with ordinary HCC before surgery. There is no evidence that adjuvant therapy including chemotherapy, radiotherapy and target therapy may improve the survival rate. It would usually be diagnosed as atypical HCC and treated as ordinary HCC, however, the prognosis is much worse; this sarcomatosis type HCC should be seriously considered.

Jejunogastric intussusception presented with hematemesis: A case presentation and review of the literature

Jejunogastric intussusception (JGI) is a rare but life‐threatening complication of gastrectomy. It is a complication of previous surgery on the stomach, such as Billroth II gastrectomy, Roux‐en‐Y anastomosis, and gastrojejunostomy. Early diagnosis is important but difficult in acute JGI. Emergency surgical intervention is necessary in most cases and can prevent clinical deterioration. We report such a case that presented with hematemesis.

Off-treatment efficacy of 3-year nucleos(t)ide analogues in chronic hepatitis B patients.

Lamivudine, telbivudine, and entecavir are the first‐line drugs covered by the Taiwan National Health Insurance as 3‐year treatments for patients with chronic hepatitis B virus (HBV), but the optimal treatment duration of each remains unclear. We aimed to detect HBV treatment‐cessation durability, and compare the predictors in patients with and without clinical relapse. In this retrospective cohort study, 210 patients with chronic HBV who tested hepatitis B e‐antigen positive or hepatitis B e‐antigen negative were treated for 3 years with a nucleos(t)ide analogue. Of these, 102 patients continued therapy after 3 years, while 88 patients stopped treatment and were followed for 1 year due to financial difficulties. Efficacy was assessed in terms of alanine aminotransferase (ALT) level normalization, HBV DNA clearance, virus breakthrough, clinical relapse, and liver decompensation. The durability predictors were evaluated by host factors, HBV DNA, and drug differences. Eighty patients (14 on lamivudine, 19 on telbivudine, and 47 on entecavir) were recruited. There was no difference in clinical‐relapse rate among lamivudine, telbivudine, and entecavir (35.7% vs. 36.8% vs. 31.9%, respectively; p = 0.916), and liver decompensated hepatitis was absent. In baseline clinical characteristics, there were no differences between the clinical‐relapse and nonrelapse groups in age, sex, cirrhosis, prior treatment, HBV DNA, pretreatment ALT, or hepatitis B e‐antigen (HBeAg). The mean 3rd year serum ALT level differed significantly between clinical‐relapse and nonrelapse patients (37.5 U/L vs. 27.7 U/L, respectively; p = 0.044). The 3‐year nucleos(t)ide analogue off‐treatment in patients with chronic HBV delivered according to the Taiwan National Health Insurance guidelines had an overall 33.8% 1‐year clinical‐relapse rate without any decompensated hepatitis flare‐ups.

Ectopic sebaceous gland in the esophagus—Case reports and review of the literature

Ectopic sebaceous glands (ESGs) are benign esophageal lesions that have a lower detection rate than malignant lesions because most patients are asymptomatic. However, this rate can be increased by the widespread use of endoscopes and an increasing awareness of the disease. Through esophagogastroduodenoscopy, ESGs often appear in the middle and lower esophagus in numbers ranging from 1 to more than 100 yellowish plaques measuring 1–2 mm in diameter. Histopathological examination of ESGs would reveal small lobular cluster glands in the lamina propria. Diagnosis is usually confirmed through an endoscopic biopsy. ESGs are best distinguished from other yellowish lesions such as xanthoma via endoscopy. These lesions tend to appear singly scattered, whereas xanthomas tend to be clustered. We present three cases of ESGs in the esophagus. Although their etiologies are still unclear, we present related theories in our review.